AccountId: 011433970860
ContactId: abcd61af-731c-43c4-b998-f4cfb66e2146
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 226929 ms
Total Talk Time (AGENT): 104991 ms
Total Talk Time (CUSTOMER): 77582 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/abcd61af-731c-43c4-b998-f4cfb66e2146_20250522T12:40_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, good morning. I'm calling for benefits and eligibility, please. My name is [PII], spelled [PII].
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the eligibility and benefits, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, of course it's gonna be [PII].
[CUSTOMER][NEUTRAL] And um the policy number of the patient's gonna be 02100309 M as in Mike L as in Liam 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, it's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII]. It's [PII] and it's [PII].
[AGENT][NEUTRAL] And what's the first name?
[CUSTOMER][NEUTRAL] The first name I'm gonna spell it is [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, and thank you so much for verifying her information and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] For a specialist office visit and outpatient surgery, please.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So for outpatient, the policy will pay up to $7350 per person per calendar year. There is no deductible.
[AGENT][NEUTRAL] That does include surgery in the hospital outpatient facility or free-standing outpatient surgery center.
[AGENT][NEUTRAL] The policy itself doesn't have any coverage for the office setting, but they do have the office treatment rider. So any treatment done in the office as long as it's not cosmetic could be covered up to that 7350.
[AGENT][NEUTRAL] Per year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So office visit is not covered?
[AGENT][NEUTRAL] If you bill for like a 99213 or 99214, like an office visit code, the facility, there's no coverage for the facility, but the treatment, she has the office treatment rider added, so whatever treatment is done in the office could be covered.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, and how much has been accumulated out of the 7350?
[AGENT][NEUTRAL] Let's see, hold on one moment.
[CUSTOMER][NEUTRAL] And you said it was per calendar year, correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] So she's used $3,653.40.
[AGENT][NEUTRAL] She has
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] 3
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Mm mhm. No, I'm sorry, yeah, go.
[AGENT][NEUTRAL] She
[AGENT][NEUTRAL] She has $3,696.60 left for 2025.
[CUSTOMER][POSITIVE] Perfect. Thank you so much. And the reference number would be your name in today's date, correct?
[AGENT][NEUTRAL] Yes, and the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much. You have a great rest of your Thursday. Have a good weekend.
[AGENT][NEUTRAL] You're welcome, OK.
[AGENT][NEUTRAL] You also, was there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, that was all. Thank you so much.
[AGENT][POSITIVE] Alright, thanks for calling APL. You're welcome bye bye.
[CUSTOMER][NEUTRAL] Bye.